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Öğe Aseptic meningitis caused by Coronavirus OC43 in a child: A case report(Bayrakol Medical Publisher, 2022) Demirbaş, Yasemin; Alpcan, Ayşegül; İnal, Mikail; Güney, Şeyma; Tursun, Serkan; Kandur, YaşarHuman coronavirus OC43 (HCoV-OC43) is one of the coronaviruses that cause the mild cold. On the other hand, extra-respiratory manifestations such as cen-tral nervous system infections with HCoV-OC43 are very rarely reported. We present a case of a previously healthy immunocompetent child with acute aseptic meningitis, as a result of HCoV-OC43 who admitted to the emergency department with a complaint of unconsciousness.. Respiratory tract and cerebrospinal fluid culture showed HCoV-OC43 in viral screening. During the follow-up period, the patient was completely asymptomatic, with normalized consciousness. The clinicians should keep in mind that HCoV-OC43 can be the etiological agent in the differential diagnosis of aseptic meningitis in immunocompetent individuals with reversible neurological symptoms.Öğe Cranial Magnetic Resonance Imaging Findings of Bonzai Abuse: A Case Report(2016) Burulday, Veysel; Koç, Ural; Tan, Sinan; İnal, Mikail; Alpua, MuratSentetik kannabinoidler (SK) Avrupa da Spice, ABD de K2, diğer taraftan Türkiye de Bonzai ismiyle popülerleş- mişlerdir. Çağımızın tehlikesi Bonzai, komplikasyonları ve nöroradyolojik bulguları literatürde çok bilinmeyen, son zamanlarda Türkiye de popüler olan bir bitkisel kaynaklı sentetik kannabinoid ilaçtır. Bunun sonucu olarak Bon- zai veya Bonzai ilişkili komplikasyonlar konusunda rad- yoloğun nöroradyolojik olarak farkında olması önemlidir. Biz bu olgu sunumunda, bilgisayarlı tomografide iskemi ile ilişkili olabilecek hipodens alanları olan, diğer taraf- tan magnetik rezonans görüntülemesinde T2 ağırlıklı ve FLAIR sekanslarda vazojenik ödemle uyumlu olduğu dü- şünülen Bonzai suistimali olgusunun kranial görüntüleme bulgularını sunduk. Ek olarak FLAIR görüntülemede kor- pus kallozumda sinyal artışı ve kanama odakları izlendi.Öğe Criteria for distinguishing the appendix from ileal segments sonographically: a different perspective(2016) İnal, Mikail; Daphan, Birsen Ünal; Karadeniz, M Yasemin BilgiliAmaç: Biz bu çalışmada normal veya patolojik apendiksin ileal segmentlerden sonografik olarak ayırtedilebilmesi için gerekli yeni ve objektif kriterler tespit etmeyi amaçladık.Materyal ve Metodlar: Normal ve patolojik apendikslerin, ileumun ikinci ve üçüncü formlarının transvers ultrasonografik kesitleri üzerinde milimetrik olarak uzun çap, kısa çap, ortalama çap, dairesellik indeksi, ve çap indeksi hesaplandı.Bulgular: Dairesellik indeksi, sirkülarite indeksi ve uzun çap, normal veya patolojik apendiksin ileal segmentlerden ayırtedilmesinde yüksek oranda sensitivite ve spesifisite gösterdi.Sonuç: Dairesellik indeksi, sirkülarite indeksi ve uzun çap normal veya patolojik apendiksin ileumdan ultrasonografik olarak ayırtedilmesinde objektif ve etkin kriterlerdirÖğe A different view of the sonographic classification of the appendix(2016) İnal, Mikail; Daphan, Birsen Ünal; Karadeniz, M. Yasemin BilgilAmaç: Biz bu çalışmada farklı lokalizasyonlardaki apendiksleri inceleyerek önceki literatürden farklı bir sınıflama yapmayı ve böylece appendiksin sonografik incelemesini kolaylaştırmayı amaçladık.Materyal ve metod: Çalışma bizim departmanımıza pelvik veya batın ultrasonografisi amacı ile başvuran 362 ardışık hasta üzerinde gerçekleştirildi. Normal sonografik apendiks kriterleri maksimum çapı 6 mm olan, komprese olan, kör sonlanan tübüler yapı olarak belirlendi. Appendiksler ultrasonografi ile incelendi ve kaydedildi, referans çizgisi olarak da sağ iliak fossadaki iliak damarlar alındı.Bulgular: Apendiksler yerleşim yerine göre 1-8 sınıfa ayrıldı. Tip 1 iliak damarları geçen (85.5%),tip 2 iliak damarların hemen yanında (2.41%), tip 3 çekumun inferior ve lateralinde (1.93%), tip 4 sağ parakolik olukta (4.34%), tip 5 tamamen retroçekal (1.93%), tip 6 çekumun anteriorunda (1.45%), tip 7 umblikusa uzanan (0.97%) and tip 8 çekal malpozisyonla birlikte subhepatik yerleşim (1.45%).Sonuç: Bu çalışmada literatürde daha önceden tanımlanandan farklı olarak yeni bir sınıflama sistemi ortaya konulmuştur. Normal ve anormal apendikslerin en sık görülen yerleşimi iliak damarları geçen tip 1 olarak izlendi. İkinci en sık görülen yerleşim ise sağ parakolik olukta izlenen tip 4 idi. İki farklı ilginç yerleşim ise umblikusa uzanan tip 7 ile subhepatik alana uzanan tip8 idiÖğe Diffusion-weighted magnetic resonance imaging in diabetic retinopathy(2018) Burulday, Veysel; Örnek, Kemal; İnal, Mikail; Güler, Hatice Ayhan; Daphan, Birsen Ünal; Örnek, NurgülDiabetic retinopathy (DR) is a complication of diabetes mellitus (DM) that may causes blindness. The vitreous is an extracellular matrix and it may have changes through liquefaction and syneresis in patients with DM, even in those without apparent DR. Diffusion-weighted imaging (DWI) is a new technique provide tissue contrast relying on difference with the diffusion of water molecules among tissues, which can be measured by the apparent diffusion coefficient (ADC) value. We aimed to investigate the vitreous of patients in different stages of DR using diffusion-weighted imaging technique. This prospective study included a group of 100 patients with DR and 100 members of an age- and gender-matched control group. All groups were tested using a head coil in conduction with a Achieva 1.5T magnetic resonans imaging (MRI) system (Philips Medical Systems, Best, The Netherlands). The mean ADC values were calculated and used for statistical comparisons. Mean duration of diabetes was 12.22±10.13 years in patients. Compared to controls, both eyes of the DR group had statistically and significantly lower values of ADC (p=0.025 and p=0.002, respectively). No significant correlations were found among the ADC values and central macular thickness, disease duration and stage of DR (all p>0.05) in patients. Mean ADC values revealed no significant differences among the subgroups of patients at different stages of DR (all p>0.05). Decreased ADCs in the vitreous of diabetes patients seem to be associated with the presence of diabetic retinopathy.Öğe Effect of intravitreal bevacizumab on retrobulbar blood flow of patients with diabetic macular edema(Wichtig Publ, 2015) Örnek, Nurgül; İnal, Mikail; Erbahceci, Inci Elif; Oğurel, Tevfik; Örnek, KemalPurpose: To determine the effect of intravitreal bevacizumab on retrobulbar blood flow of patients with diabetic macular edema. Methods: Peak systolic velocity, end-diastolic velocity, resistance, and pulsatility indices of central retinal artery (CRA), nasal posterior ciliary artery (NPCA), temporal posterior ciliary artery (TPCA), and ophthalmic artery (OA) were assessed by color Doppler ultrasonography in injected and uninjected eyes of 37 patients at baseline and at day 1 and day 7 after the injection. Results: At day 1 after the injection, peak systolic and end diastolic velocities of the CRA and NPCA in the injected eyes and peak systolic velocity of NPCA in the uninjected eyes decreased significantly (p<0.05, p = 0.025, respectively). Peak systolic and end diastolic velocities were not significantly different in the injected and uninjected eyes at day 7 after the injection (p>0.05). In the injected eyes, there was no significant change in resistance and pulsatility indices (p>0.05), but a decrease in resistance index of NPCA and resistance and pulsatility indices of TPCA occurred in uninjected eyes at day 7 after the injection (p = 0.016, p = 0.023, and p = 0.025, respectively). Conclusions: Intravitreal bevacizumab affects retrobulbar blood flow in injected and uninjected eyes of patients with diabetic macular edema.Öğe The Epidermoid Cyst Containing Free Teeth in The Maxillary Sinus(2018) Taş, Burak Mustafa; Şimşek, Gökce; Akay, Neşet; İnal, Mikail; Kılıç, RahmiEpidermoid cysts (EC) are the most common tumors of the skin. They are usually asymptomatic and small-sized. They are more common at young ages. They grow slowly and are painless. The wall of EC is covered with epidermis-like epithelium. EC are rarely seen in sinuses. In our case, a 16-year-old female presented with complaints of swelling and headache that started from the left eye and extended to the upper lip. A biopsy was performed at another hospital of the patient who had previously received medical treatment but had no complaints. A cystic mass containing teeth was observed in the left maxillary sinus on imaging. The cystic mass was excised along with the wall. Pathological results supported the diagnosis of EC. Treatment of EC are surgical and recurrence rates are low. Although many masses are observed in the sinonasal region, epidermoid cysts are rare. It is important to distinguish epidermoid cysts from malignant masses that exhibit expansile growth characteristics. Keywords: Headache, epidermoid cyst, maxillary sinusÖğe Evaluation of hip angles with magnetic resonance imaging in femoroacetabular impingement syndrome(2020) Kültür, Turgut; İnal, MikailIntroduction: It was aimed to compare the patients having clinical and radiological diagnosis of femoroacetabular impingement syndrome with the control group by magnetic resonance imaging, and alpha angle and the central corner angle described by Wiberg. Material and Method: Routine hip MRIs were analyzed retrospectively between January 2016 and May 2019. Clinically and radiologically, patients diagnosed with cam, pincer, and mixed FAI were recorded. A control group matching age and sex was created. The alpha angle was determined as the angle between the line drawn from the center of the femoral neck to the center of the femoral head in axial T1A magnetic resonance imaging, and the line drawn from the center of the femoral head to the point where the femoral head begins to turn towards the neck.Central corner angle of Wiberg’s was measured as the angle between the perpendicular line drawn from the center of the femoral head to the acetabulum on the coronal T1A images and the line connecting the outermost point of the acetabulum. Measurements were compared statistically in both groups. p<0.05 was considered statistically significant. Results: 16 of 28 patients (18 men, 10 women) with FAI had impingement in both hips and a total of 44 hips were examined. There were 9 cam, 23 pincer and 12 mixed impingement cases in the patient group. When FAI and control groups were compared, alpha and Wiberg’s angles were found to be significantly different (p<0.05). In subgroup analysis, there was a significant difference between cam type and control group, mixed type and control group, pincer type and cam type, pincer type and mixed type in terms of alpha angles (p<0.05). For Wiberg’s angles, a significant difference was found between pincer type and control group, mixed type and control group, pincer type and cam type, mixed type and cam type (p<0.05). Cut off values were 54.45 (auc=0.64) for alpha angle and 37.30 (auc=0.83) for Wiberg angle. Conclusion: Alpha angle measurement cam type and Wiberg angle measurement provide useful information for the diagnosis of pincer type impingement with MRI.Öğe Evaluation of putamen area and cerebral peduncle with surrounding cistern in patients with Parkinson’s disease: is there a difference from controls in cranial MRI?(Taylor and Francis Ltd., 2024) Say, Bahar; Bayar Muluk, Nuray; İnal, Mikail; Göncüoğlu, Alper; Yörübulut, Serap; Ergün, UfukObjectives: Nigrostriatal dopaminergic neuron loss is essential in pathogenesis of Parkinson’s disease (PD). The purpose of this study was to evaluate nigrostriatal structures including the putamen, cerebral peduncle, widths of interpeduncular cistern, and ambient cistern around the midbrain with conventional cranial magnetic resonance images (MRI) in patients with PD. Methods: The MRI of 56 subjects was included, which was selected from the radiological data system for this retrospective study. The 29 patients with idiopathic PD were included and their disease duration, Hoehn&Yahr stage, and Levodopa equivalent dose (LED) were recorded. The 27 controls had a normal neurologic examination and cranial MRI. All subjects in the patient and control groups had right-hand dominance. Putamen and cerebral peduncle areas and widths of interpeduncular and ambient cisterns were measured in T2 sequences of MRI. Further statistical analysis was applied to exclude gender and age effect on areas. Results: The areas of putamen and cerebral peduncles were significantly reduced in patients with PD compared to the control bilaterally (p < 0.001). Enlargement of interpeduncular and ambient cisterns in patients was higher than in controls, and it was significant (p < 0.001). A correlation was not observed between measurement results and clinical characteristics of patients with PD. Only the cerebral peduncle area/ambient cistern width ratio was significantly correlated with disease duration positively (right r = 0.46 p = 0.012, left r = 0.389 p = 0.037). Conclusion: Clinicians should be careful with conventional MRIs of patients with idiopathic PD in practice. It may be different from controls without any neurological disorder, particularly putamen, cerebral peduncles, interpeduncular, and ambient cisterns. © 2023 Informa UK Limited, trading as Taylor & Francis Group.Öğe Maksiller sinüsün Mantle hücreli lenfoması: olgu sunumu(2018) Akay, Neşet; Şimşek, Gökçe; Yalçın, Selim; İnal, Mikail; Özgedik, Balcı Mahi; Onaran, ZaferMantle hücreli lenfoma (MHL) çok sayıda B-hücreli lenfoma subtiplerinden biridir. Ekstra nodal tutulum sıktır, en sık kemik iliği, karaciğer, dalak, Waldeyer halkası ve gastrointestinal kanal tutulumu gözlenir. Tüm habis lenfomalarda olduğu gibi tanı için eksizyonel lenf düğümü biyopsisi tercih edilir. Erken evre MHL hastalarında 3-4 kür sistemik kemoterapi sonrası radyoterapi uygulaması uygun bir tedavi yaklaşımı olarak görülmektedir. Bizim olgumuzda elli yaşında bayan hastada 1 aydır geçmeyen diş ağrısı ile birlikte yüzde şişlik, asimetri, gözde öne itilme şikayetleri mevcuttu. Radyolojik değerlendirme sonrası maksiler sinüsten alınan biyopsi sonucu Mantle Hücreli Lenfoma olarak bildirildi. Sinonazal MHL’de nazal obstrüksiyon, epistaksis, yüzde şişlik, rinit, görme bozukluğu ve gözde çıkıklık gibi nonspesifik semptomlar görülebilir. Semptomların non spesifik seyrettiği bu hastaların ayırıcı tanısında lenfoma mutlaka düşünülmelidir.Öğe Olfactory Fossa and New Angle Measurements: Lateral Lamella-Cribriform Plate Angle(Lippincott Williams & Wilkins, 2019) Asal, Neşe; Muluk, Nuray Bayar; İnal, Mikail; Şahan, Mehmet Hamdi; Doğan, Adil; Arıkan, Osman KürşatObjectives: The authors investigated the olfactory fossa (OF) in patients with unilateral nasal septal deviation (NSD) and presented the lateral lamella-cribriform plate angle (LLCPA). Methods: Paranasal sinus computed tomography images of 300 adult subjects with unilateral NSD (111 males, 189 females) were evaluated retrospectively. Septal deviation angle (SDA), Keros Classification, OF depth and width, LLCPA; and orbital plate and cribriform plate (OPCP) distance were measured. Results: The OF depth values (ipsilateral, contralateral) were found as Keros III >Keros II >Keros I (P-adjusted<0.0175). The OF width values (ipsilateral) were detected as Keros I >Keros II and Keros I >Keros III (P-adjusted<0.0175). In patients with higher SDA values, ipsilateral OF depth values decreased (P<0.05). The LLCPA and OPCP values were higher in Keros I and lower in Keros III (P<0.05). Conclusion: In patients with lower LLCPA and OPCP, endoscopic sinus surgery will be more dangerous for trauma to lateral lamella and intracranial penetration.Öğe Pneumosiderosis in a Welder Masquerading as Hypersensitivity Pneumonitis Caused by Pigeons(2015) Baççıoğlu, Ayşe; Kalpaklıoğlu, Ayşe Füsun; Bozdoğan, Önder; İnal, Mikail; Güngör, ÖmürA 43-year-old man with a dyspnea, and cough had been a welder for 20 years, and had raised pigeons for 30 years. A pre-diagnosis of hypersensitivity pneumonitis was proposed with multiple micronodular opacities in radiology, exposure to pigeons, and hypoxemia. However, it was ruled out with continuing lung symptoms though avoidance of pigeons, no alveolitis in the bronchial lavage, corticosteroid insensitivity, and normal diffusion lung capacity. A diagnosis of welder’s lung disease was made with the occupational environment consisting of iron dust particles, compatible chest radiology, and positive staining for ferritin (Prussian blue stain) of the macrophages in the bronchial lavage. His hypoxemia was thought to improve after bronchial washing. He was recommended to quit his job and quit smoking, as well as feeding pigeons, since these factors potentially had an effect and predispose lung fibrosis, asthma, and cancer.Öğe Threshold Based Image Enhancement Method for Low Contrast X-Ray Images Using CLAHE(Kırıkkale Üniversitesi, 2022) Hatipoğlu, Buğra; Karagöz, Prof. Dr. İrfan; İnal, MikailWhile a large dataset in deep learning may seem like a positive factor, it may not always produce good results. Image quality is one of the factors that directly affects model performance, which in turn affects the quality of training. In this study, the effect of low contrast X-ray images on the detection of Covid-19 and pneumonia was investigated. Because the details are extremely important in the detection of these diseases. If the images are low contrast, it can cause some details to be missed in the detection of the disease. This problem can be solved using adaptive histogram methods such as CLAHE. The CLAHE method can apply various filters to low contrast images to bring them to the desired levels. The data set contains 8849 human lung X-ray images. The Vgg16 model was used for training. Vgg16 is a state of the art model architecture in deep learning. The image dimensions are 150x150. Classification performed before low-contrast images were filtered achieved 95.22% accuracy. After filtering based on the threshold value, accuracy increased to 97.35%. In the next stage, by searching for the best values for the parameters, accuracy was increased to 97.86%.Öğe Yalnızca Medikal Tedavi İle Düzelen Multiple İntrarenal Apse Olgusu(2015) Gül, Serdar; Kaçmaz, Birgül; İnal, Mikail; Gülhan, Muhammet; Ecemiş, Kenanİntrarenal apseler, akut piyelonefritin komplikasyonu olarak veya hematojen yolla gelişebilmekte- dir. Piyelonefritin komplikasyonu olarak gelişen apseler genellikle kortekste, medullada veya her ikinde birlikte yerleşir ve etken genellikle Gram negatif enterik bakterilerdir. Hematojen yolla olu- şan apseler ise genellikle kortekste yerleşir, tektir ve etken de hemen her zaman stafilokoklardır. Tanıda idrar mikroskopisi normal olabileceği için, bilgisayarlı tomografi veya ultrasonografi gibi görüntüleme yöntemlerinin önemi büyüktür. İntrarenal abseler, özellikle çocuklarda, erken tedavi edilmediğinde böbrek hasarına yol açabilir. Tedavide antibiyoterapi genellikle tek başına yeterli olabilmekle birlikte, özellikle büyük boyuttaki apselerde cerrahi girişime ihtiyaç duyulabilmektedir. Bu çalışmada sadece medikal tedavi ile düzelen, multiple renal apseleri olan bir olguyu sunmayı amaçladık.
